| NPI | 1922786540 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD.MD.61673454) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: WA ML61458827) |
| Enumeration Date | 2023-07-05 |
| Last Update Date | 2025-08-18 |